Billing FAQs for Personal Injury Patients
What is a personal injury case?
A personal injury case arises when a patient receives medical treatment for injuries caused by an accident or incident involving another party, such as a motor vehicle collision, slip and fall, etc., where the other party may be legally responsible.
In Nebraska, medical providers are generally required to bill available health insurance first, even when treatment relates to a personal injury claim. A pending legal claim does not replace standard insurance billing requirements.
Does this include Medicare and Medicaid?
Yes! When a patient has Medicare or Medicaid, providers must bill those programs first in accordance with federal and state law.
Medicare and Medicaid cannot be bypassed in favor of a lien or letter of protection.
Providers may not delay billing these programs while waiting for a settlement.
Failure to properly bill Medicare or Medicaid can result in:
Claim denials
Payment delays
Compliance issues for providers
Unexpected balances for patients
What if the patient has private health insurance?
If the patient has active private health insurance, providers should submit claims to the health insurer first, subject to plan rules and coverage terms.
In Nebraska, the existence of a liability claim does not eliminate the requirement to bill health insurance first.
What about a medical lien or letter of protection?
A lien:
Does not replace required insurance billing
Does not guarantee payment
May apply only to balances not covered by insurance
Who is responsible for copays, deductibles, and non‑covered charges?
The patient remains responsible for:
Insurance copays and deductibles
Non‑covered or denied charges
Balances not paid by insurance, subject to applicable laws and agreements
This will be paid out of the patient’s settlement, if applicable.
When does the provider bill the liability insurer or settlement?
After health insurance (including Medicare or Medicaid) has been billed and adjudicated, a provider may:
Assert a lien for qualifying unpaid balances, or
Coordinate payment through the patient or their attorney, if appropriate
Does an attorney control medical billing?
No. Attorneys do not determine how providers must bill for medical services. Providers are responsible for complying with insurance, state, and federal billing rules regardless of legal representation.
What happens if there is no settlement?
Billing responsibilities do not change. Insurance remains primary, and the patient may still be responsible for applicable out‑of‑pocket costs consistent with their coverage.
Unanswered questions?
Let us help!
Ph: 531-249-1605
Fax: 531-249-1536
Email: katie@urbommaaske.com